BILL NUMBER: SB 1104 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Cedillo
FEBRUARY 17, 2010
An act to amend Section 1367.51 of the Health and Safety Code, and
to amend Section 10176.61 of the Insurance Code, relating to health
care coverage.
LEGISLATIVE COUNSEL'S DIGEST
SB 1104, as introduced, Cedillo. Health care coverage:
diabetes-related complications.
Existing law, the Knox-Keene Health Care Service Plan Act of 1975,
provides for the licensure and regulation of health care service
plans by the Department of Managed Health Care and makes a willful
violation of the act a crime. Existing law also provides for the
regulation of health insurers by the Department of Insurance.
Existing law requires specified health care service plan contracts
and health insurance policies to provide coverage for certain
equipment, supplies, and medications for the treatment of diabetes,
including podiatric devices to prevent or treat diabetes-related
complications. Existing law also requires a plan or insurer to
provide coverage for diabetes outpatient self-management training,
education, and medical nutrition therapy necessary to enable an
enrollee or insured to properly use the equipment, supplies, and
medications.
This bill would require health care service plan contracts and
health insurance policies to also provide coverage for the diagnosis
and treatment of diabetes-related complications, as specified.
Because a willful violation of this requirement by a health care
service plan would be a crime, the bill would impose a state-mandated
local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1367.51 of the Health and Safety Code is
amended to read:
1367.51. (a) Every health care service plan contract, except a
specialized health care service plan contract, that is issued,
amended, delivered, or renewed on or after January 1, 2000, and that
covers hospital, medical, or surgical expenses shall include coverage
for the following equipment and supplies for the management and
treatment of insulin-using diabetes, non-insulin-using diabetes, and
gestational diabetes as medically necessary, even if the items are
available without a prescription:
(1) Blood glucose monitors and blood glucose testing strips.
(2) Blood glucose monitors designed to assist the visually
impaired.
(3) Insulin pumps and all related necessary supplies.
(4) Ketone urine testing strips.
(5) Lancets and lancet puncture devices.
(6) Pen delivery systems for the administration of insulin.
(7) Podiatric devices to prevent or treat diabetes-related
complications.
(8) Insulin syringes.
(9) Visual aids, excluding eyewear, to assist the visually
impaired with proper dosing of insulin.
(b) Every health care service plan contract, except a specialized
health care service plan contract, that is issued, amended,
delivered, or renewed on or after January 1, 2000, that covers
prescription benefits shall include coverage for the following
prescription items if the items are determined to be medically
necessary:
(1) Insulin.
(2) Prescriptive Prescription
medications for the treatment of diabetes.
(3) Glucagon.
(c) Every health care service plan contract, except a specialized
health care service plan contract, that is issued, amended,
delivered, or renewed on or after January 1, 2011, and that covers
hospital, medical, or surgical expenses, shall provide coverage for
the diagnosis and treatment of diabetes-related complications. With
respect to contracts that cover prescription benefits, the coverage
required by this subdivision shall include coverage of prescription
medications for the treatment of diabetes-related complications. For
purposes of this subdivision, "diabetes-related complications"
includes, but is not limited to, diabetic peripheral neuropathy.
(c)
(d) The copayments and deductibles for the benefits
specified in subdivisions (a) and , (b)
, and (c) shall not exceed those established for similar
benefits within the given plan.
(d)
(e) Every plan shall provide coverage for diabetes
outpatient self-management training, education, and medical nutrition
therapy necessary to enable an enrollee to properly use the
equipment, supplies, and medications set forth in subdivisions (a)
and (b), and additional diabetes outpatient self-management training,
education, and medical nutrition therapy upon the direction or
prescription of those services by the enrollee's participating
physician. If a plan delegates outpatient self-management training to
contracting providers, the plan shall require contracting providers
to ensure that diabetes outpatient self-management training,
education, and medical nutrition therapy are provided by
appropriately licensed or registered health care professionals.
(e)
(f) The diabetes outpatient self-management training,
education, and medical nutrition therapy services identified in
subdivision (d) (e) shall be provided
by appropriately licensed or registered health care professionals as
prescribed by a participating health care professional legally
authorized to prescribe the service. These benefits shall include,
but not be limited to, instruction that will enable diabetic patients
and their families to gain an understanding of the diabetic disease
process, and the daily management of diabetic therapy, in order to
thereby avoid frequent hospitalizations and complications.
(f)
(g) The copayments for the benefits specified in
subdivision (d) (e) shall not exceed
those established for physician office visits by the plan.
(g)
(h) Every health care service plan governed by this
section shall disclose the benefits covered pursuant to this section
in the plan's evidence of coverage and disclosure forms.
(h)
(i) A health care service plan may not reduce or
eliminate coverage as a result of the requirements of this section.
(i)
(j) Nothing in this section shall be construed to deny
or restrict in any way the department's authority to ensure plan
compliance with this chapter when a plan provides coverage for
prescription drugs.
SEC. 2. Section 10176.61 of the Insurance Code is amended to read:
10176.61. (a) Every insurer issuing, amending, delivering, or
renewing a disability health insurance
policy on or after January 1, 2000, that covers hospital,
medical, or surgical expenses shall include coverage for
the following equipment and supplies for the management and treatment
of insulin-using diabetes, non-insulin-using diabetes, and
gestational diabetes as medically necessary, even if the items are
available without a prescription:
(1) Blood glucose monitors and blood glucose testing strips.
(2) Blood glucose monitors designed to assist the visually
impaired.
(3) Insulin pumps and all related necessary supplies.
(4) Ketone urine testing strips.
(5) Lancets and lancet puncture devices.
(6) Pen delivery systems for the administration of insulin.
(7) Podiatric devices to prevent or treat diabetes-related
complications.
(8) Insulin syringes.
(9) Visual aids, excluding eyewear, to assist the visually
impaired with proper dosing of insulin.
(b) Every insurer issuing, amending, delivering, or renewing a
disability health insurance policy on
or after January 1, 2000, that covers prescription benefits shall
include coverage for the following prescription items if the items
are determined to be medically necessary:
(1) Insulin.
(2) Prescriptive Prescription
medications for the treatment of diabetes.
(3) Glucagon.
(c) Every health insurance policy that is issued, amended,
delivered, or renewed on or after January 1, 2011, shall provide
coverage for the diagnosis and treatment of diabetes-related
complications. With respect to policies that cover prescription
benefits, the coverage required by this subdivision shall include
coverage of prescription medications for the treatment of
diabetes-related complications. For purposes of this subdivision,
"diabetes-related complications" includes, but is not limited to,
diabetic peripheral neuropathy.
(c)
(d) The coinsurances and deductibles for the benefits
specified in subdivisions (a) and , (b)
, and (c) shall not exceed those established for similar
benefits within the given policy.
(d)
(e) Every health insurer shall provide
coverage for diabetes outpatient self-management training, education,
and medical nutrition therapy necessary to enable an insured to
properly use the equipment, supplies, and medications set forth in
subdivisions (a) and (b) and additional diabetes outpatient
self-management training, education, and medical nutrition therapy
upon the direction or prescription of those services by the insured's
participating physician. If an a health
insurer delegates outpatient self-management training to
contracting providers, the insurer shall require contracting
providers to ensure that diabetes outpatient self-management
training, education, and medical nutrition therapy are provided by
appropriately licensed or registered health care professionals.
(e)
(f) The diabetes outpatient self-management training,
education, and medical nutrition therapy services identified in
subdivision (d) (e) shall be provided
by appropriately licensed or registered health care professionals as
prescribed by a health care professional legally authorized to
prescribe the services.
(f)
(g) The coinsurances and deductibles for the benefits
specified in subdivision (d) (e) shall
not exceed those established for physician office visits by the
insurer.
(g)
(h) Every disability health
insurer governed by this section shall disclose the benefits
covered pursuant to this section in the insurer's evidence of
coverage and disclosure forms.
(h) An
(i) A health insurer may not
reduce or eliminate coverage as a result of the requirements of this
section.
(i)
(j) This section does not apply to vision-only,
dental-only, accident-only, specified disease, hospital indemnity,
Medicare supplement, long-term care, or disability income insurance,
except that for accident-only, specified disease, and hospital
indemnity insurance coverage, benefits under this section only apply
to the extent that the benefits are covered under the general terms
and conditions that apply to all other benefits under the policy.
Nothing in this section may be construed as imposing a new benefit
mandate on accident-only, specified disease, or hospital indemnity
insurance.
SEC. 3. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.